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目的观察碳酸镧治疗维持性血液透析患者高磷血症的短期疗效及安全性。方法选取维持性血液透析并高磷血症患者42例,随机分为两组,每组21例。试验组给予碳酸镧咀嚼片,根据患者的血磷值制定碳酸镧的使用剂量;对照组给予碳酸钙D_3咀嚼片,1片,bid;治疗周期均为12周。观察两组血磷、血钙、钙磷乘积、血全段甲状旁腺素水平变化及不良反应。结果试验组和对照组血磷分别于治疗2周和4周后出现下降,试验组血磷下降幅度大于对照组(P<0.05)。试验组治疗前后血钙水平无明显变化(均P>0.05),对照组治疗后血钙升高(P<0.05)。试验组钙磷乘积下降,且低于同时点对照组,差异显著(P<0.05)。试验组和对照组胃肠道反应发生率分别为29%和24%(P>0.05),高钙血症发生率分别为0和29%(P<0.05)。结论与碳酸钙相比,碳酸镧具有更快、更好的降血磷效果,且不会导致高钙血症,是治疗维持性血液透析患者高磷血症安全有效的药物。
Objective To observe the short-term efficacy and safety of lanthanum carbonate in the treatment of maintenance hemodialysis patients with hyperphosphatemia. Methods Twenty-two patients with maintenance hemodialysis and hyperphosphatemia were randomly divided into two groups (21 in each group). The experimental group was given lanthanum carbonate chewable tablets, lanthanum carbonate dosage was determined according to the patient’s phosphorus; the control group was given calcium carbonate D_3 chewable tablets, 1 tablet, bid; the treatment cycles were 12 weeks. Observe the changes of blood phosphorus, calcium, calcium and phosphorus, whole blood parathyroid hormone levels and adverse reactions in the two groups. Results The levels of P in test group and control group decreased at 2 weeks and 4 weeks after treatment, respectively. The decline of serum phosphorus in experimental group was larger than that in control group (P <0.05). There was no significant difference in serum calcium levels before and after treatment in the experimental group (all P> 0.05), while the serum calcium was increased in the control group after treatment (P <0.05). The test group calcium and phosphorus products decreased, and lower than the same time point control group, the difference was significant (P <0.05). The incidences of gastrointestinal reactions in the experimental and control groups were 29% and 24%, respectively (P> 0.05). The incidence of hypercalcemia was 0 and 29%, respectively (P <0.05). Conclusion Compared with calcium carbonate, lanthanum carbonate has a faster and better hypophosphatemic effect, does not cause hypercalcaemia, and is a safe and effective drug for treating hyperphosphatemia in maintenance hemodialysis patients.